Doctor Name: | TYLER GREEN |
NPI Number: | 1962640805 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PT,DPT |
License Number: | 8135 |
Business Practice Address: | 7065 Airways Blvd Suite 110 Southaven, MS - 386715873 |
Business Phone Number: | 6623498997 |
Business Fax Number: | 6623498987 |
Mailing Address: | 7065 Airways Blvd, Suite 110 SOUTHAVEN |
State: | MS |
Postal Code: | 386715873 |
Phone Number: | 6623498997 |
Fax Number: | 6623498987 |
NPI Enumeration Date: | 01/30/2009 |
NPI Last Update Date: | 09/01/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 8135 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | TN |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |